Significant reduced loss of bone mineral density after four vs. six cycles of R-CHOP: an analysis of the FLYER-trial

Abstract

Patients with diffuse large B-cell lymphoma (DLBCL) treated with the R-CHOP regime receive a high cumulative dose of prednisone. We used computer tomography-ascertained Hounsfield units (HU) as a surrogate parameter for bone mineral density (BMD) in three different locations of the L3 vertebral body at baseline and post-treatment. HU were measured in 50 patients with DLBCL of the previously published FLYER-trial which compared four cycles of R-CHOP + 2 × rituximab infusion to six cycles of R-CHOP in young, favorable DLBCL patients. In total, median loss was 26.8 HU in all patients over time. The median HU loss was significantly lower in the four cycles arm (21.3 HU vs. 41.3 HU, p = 0.023). In conclusion, young patients with DLBCL receiving R-CHOP have significant HU/BMD loss under treatment with R-CHOP. Patients receiving four cycles of R-CHOP had less HU/BMD loss than patients receiving six cycles.

Keywords:

• Bone mineral density
• B-cell lymphoma
• glucocorticoids
• steroids
• DLBCL
• R-CHOP

Acknowledgements

The authors are grateful to all patients and their relatives as well as to the participating investigators and sub-investigators of the FLYER trial for their continued support. This work contains parts of O.F.’s doctoral thesis. We thank the study trial office Homburg/Saar and Daniela Ehlert; the data management Stephanie Angel. We thank the numerous trial groups which provided image data.

Authorship contribution

Contribution: D.KM., V.L., V.P., C.B., G.H., S.S., M.B., J.T.B., O.F., L.T., A.V., M.WH., U.K., M.S., L.T., C.K., and P.J. contributed to collection, review, and/or analysis of the data; V.L. performed statistical analysis of the data; D.KM., V.L., and P.J. wrote the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work (FLYER trial) was supported by Deutsche Krebshilfe and Mildred Scheel Stiftung. Data collection, data analysis, and interpretation of data, writing of the paper, and decision to submit were left to the authors’ discretion and were not influenced.